P1309: THE DIRECT HEALTHCARE BURDEN ASSOCIATED WITH CHRONIC GRAFT-VERSUS-HOST DISEASE FOLLOWING ALLOGENEIC HAEMATOPOIETIC STEM CELL TRANSPLANT IN ENGLAND: A REAL-WORLD EVIDENCE ANALYSIS
Authors: Daniele Avenoso, Luke Skinner, Jennifer Davidson, Harriet Larvin, Caoimhe Rice, Katharina Ecsy, Arunesh Sil, Richard Hudson
Journal: HemaSphere (2023)

Topic: 22. Stem cell transplantation - Clinical Background: Chronic graft-versus-host disease (cGVHD), is a complication of haematopoietic stem cell transplant (allo-HSCT) affecting 30-40% of recipients. It is the main cause of morbidity and mortality after a curative allo-HSCT; nearly 50% of cGVHD patients will fail frontline therapy. The treatment of steroid refractory cGVHD relies on complex high cost therapies (HCTs). Few studies have quantified healthcare resource use (HCRU) and costs for these patients. Aims: To describe HCRU and costs (overall and stratified by HCT use), among patients who have developed cGvHD after allo-HSCT against matched patients who did not develop GvHD. Methods: This retrospective cohort study used Hospital Episode Statistics, an English national reimbursement dataset, to identify allo-HSCT procedures between April 2017-December 2020 using OPCS-4 codes (X33.6, W34.2-W34.6, and W99.1) in patients ≥12 years. Within this cohort cGvHD was defined using ICD-10 codes: D89.8 ≥100 days post allo-HSCT, or <100 days with a feature of cGvHD; or T86.0 with a feature of cGvHD. Results: 3,650 allo-HSCTs were identified amongst 3,542 patients of which, 821 were diagnosed with cGvHD. After matching, there were 721 patients with cGvHD and 718 without GvHD, 3 patients had two separate allo-HCST procedures included. After matching, 60.2% of patients were male with a mean age of 50 (SD16.5) years. Patients with cGvHD had a greater mean number of IP admissions (10.0 vs 6.3 ppy), annualised bed days (14.9 vs 7.2 ppy) and OP appointments (29.0 vs 15.5 ppy) than those with no GvHD. Amongst admitted patients, the mean cost of admission was ~50% higher for patients with cGvHD compared to those with no GvHD (£18,567 vs £12,468 ppy). Though there was no difference in the annual number of admissions to CC amongst patients with an admission (1.1 ppy), the number of CC bed days was greater (9.1 days vs 5.2 days ppy) and mean cost of CC was almost double (£21,408 vs £11,792 ppy) for patients with cGvHD. After initiation of HCTs, the mean number of IP admissions was higher (14.6 vs 8.2 ppy) than without HCTs, and was reflected in the costs (£21,137 vs £15,956 ppy, respectively). There were greater numbers of OP appointments once patients required HCTs (35.2 vs 26.7 ppy). Though there was no difference in the annual number of CC admissions (0.1 ppy), mean costs of CC were greater (£1,419 ppy vs £1,004 ppy) after HCT was required. Summary/Conclusion: cGVHD management is complex and associated with greater IP and OP HCRU and elevated healthcare costs, even after patients require HCTs. This highlights the frailty of this group of patients and the current challenges in the management of cGVHD. This study was funded by Sanofi.Keywords: Chronic graft-versus-host, Allogeneic hematopoietic stem cell transplant, Real world data, Cost analysis